长期住院精神分裂症患者伴发代谢综合征的调查

目的 研究长期住院精神分裂症患者的代谢综合征患病情况.方法 以长期住院的精神分裂症患者为研究对象,进行一般资料问卷调查和实验室检查,包括血糖和脂代谢相关指标.结果 资料完整的421例长期住院精神分裂症患者,伴发代谢综合征者131例,占31％,女性高于男性,精神分裂症合并代谢综合征患者生活质量明显下降.结论 长期住院的精神分裂症患者易合并代谢综合征,应重视相关代谢高危因素并及早进行干预.     

住院精神分裂症患者伴发代谢综合征的临床分析

目的调查住院精神分裂症患者代谢综合征的发生率,分析与代谢综合征有关的危险因素。方法将符合CCMD-3诊断标准的住院精神分裂症患者为研究对象,以2004年中华医学会糖尿病分会代谢综合征为标准,了解精神分裂症患者伴发代谢综合征的发生率,并用Logistic回归分析其相关因素。结果符合入组条件者共726例,精神分裂症患者伴发代谢综合征患病率为32.3%。代谢综合征患病相关的危险因素为年龄、氯氮平及精神分裂症的病程（P〈0.05）。Logistis回归分析结果显示,精神分裂症患者伴发代谢综合征的危险因素是高龄,病程。结论与普通人群相比,精神分裂症患者具有较高伴发代谢综合征患病风险,可能的危险因素为高龄,病程长和服用氯氮平等。     

长期氯氮平治疗引发代谢综合征调查

目的:了解长期服用氯氮平的慢性精神分裂症患者伴发代谢综合征(MS)的发生率及相关因素.方法:对370例长期服用氯氮平治疗的慢性住院精神分裂症患者测量身高、体质量、腰围和血压,空腹血糖、血总胆固醇、三酰甘油、高密度脂蛋白胆固醇及进行氯氮平血药浓度测定.结果:长期服用氯氮平治疗的慢性住院精神分裂症患者高血糖、高血压、肥胖、血脂异常及MS的发生率分别为33.2%、24.3%、42.4%、54.9%及19.5%,结论:长期服用氯氮平治疗的慢性住院精神分裂症患者伴发代谢综合征的发生率较高.     

住院精神分裂症患者代谢综合征的患病率及相关因素

目的 了解住院精神分裂症患者代谢综合征的患病率及其相关因素.方法 对上海市精神卫生中心分部住院的精神分裂症患者作调查,测定其代谢指标,采用世界糖尿病联盟(IDF)全球统一标准定义代谢综合征.结果 共入组483人,其中男性272人(56.3%),女性211人(43.7%),平均年龄(53±10)岁(19～82岁).住院精神分裂症患者代谢综合征的患病率为43.9%(213/483),女性的患病率(118/211,55.9%)高于男性的(94/272,36.4%)(χ2=22.0,P<0.05).患病率随年龄增加而增加.大于41岁的患者中女性的代谢综合征患病率均高于男性.Logistic回归发现代谢综合征与性别有关.结论 在精神分裂症患者尤其女性患者中存在较多的代谢综合征,疾病早期即应予以关注.     

住院精神分裂症患者阻塞性睡眠呼吸暂停低通气综合征的初步筛查

目的 调查住院精神分裂症患者中阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的患病情况.方法 对825例住院精神分裂症患者进行有关体重指数、打鼾、嗜睡情况等问卷调查,运用体重指数、打鼾程度评价及嗜睡评价量表评分进行OSAHS的初步筛查,并对OSAHS可能的危险因素进行分析.结果 初步筛查OSAHS患者61例（男性53例,女性8例）,患病率为7.39%（男性8.6%,女性3.8%）,男性患病率显著高于女性患病率（χ2=5.462,P＜0.05）.OSAHS患者中伴发高血压、糖尿病、高血脂的发生率（分别为36.1%,41.0%,44.3%）高于住院精神分裂症患者伴发高血压、糖尿病、高血脂的发生率（分别为21.6%,18.5%,25.4%）,存在统计学差异（χ2=6.746,17.837,10.256;均P＜0.01）.结论 住院精神分裂症患者中具有较高的OSAHS患病率,高血压、糖尿病和高脂血症可能是OSAHS危险因素.     

住院双相障碍与精神分裂症患者代谢相关障碍的对照研究

目的 了解双相障碍住院患者的肥胖与代谢相关障碍,并与精神分裂症住院患者作一比较.方法 对上海市精神卫生中心分部2008年7月住院期间的双相障碍患者作调查,测定其身高、体重及各代谢指标,用世界糖尿病联盟全球统一标准(IDF)定义代谢综合征及中心性肥胖.随机选取同期住院的两个病房的精神分裂症患者作为比较.结果 共入组双相障碍患者30例,精神分裂症160例.代谢综合征的患病率均较高,肥胖与代谢相关指标如血压、血糖、血脂方面,双相障碍患者与精神分裂症患者的患病率均无统计学差异(P>0.05).二组的超重、高甘油三酯、低HDL及中心性肥胖的比例均明显增高(P>0.05).结论 在住院的双相障碍及精神分裂症患者中同样存在较多代谢相关障碍,需要政策层面的关注.     

精神分裂症患者伴发代谢综合征的患病率调查

目的调查国内精神分裂症患者中代谢综合征的患病率及分析可能的相关影响因素。方法对住院的精神分裂症患者进行问卷调查和实验室测定，代谢综合征的诊断标准采用2004年中华医学会糖尿病分会代谢综合征标准。结果符合入组条件者共完成602例。精神分裂症患者中代谢综合征患病率为35．5％。与代谢综合征患病风险相关的危险因素包括年龄、性别、抗精神病药物种类及精神分裂症的病程（P〈0．05）。Logistic回归分析结果显示，女性精神分裂症患者罹患代谢综合征的相对危险度明显高于男性。年龄的相对危险度为12．27（95％CI2．238-32．557）。抗精神病药物种类与代谢综合征的患病风险有关（P=0．047〈0．05）。结论与普通人群相比，精神分裂症患者具有较高的代谢综合征发病风险，可能的危险因素包括女性、高龄、病程长及服用氯氮平药物等。     

慢性精神分裂症伴代谢综合征的认知功能研究

目的 探讨慢性精神分裂症伴发代谢综合征患者的认知功能缺损特征.方法 选择符合中国精神障碍分类与诊断标准第3版(CCMD-3)诊断标准的慢性精神分裂症住院患者205例,其中伴代谢综合征者(MS组)92例,无代谢综合征者(非MS组)113例.收集临床资料,采用阳性和阴性症状量表(PANSS)及治疗中出现的症状量表(TESS)评定临床症状和不良反应;重复性成套神经心理状态测验(RBANS)评定认知功能.结果 MS组与非MS组的PANSS及TESS评分均无显著性差异(P均＞0.05).MS组的RBANS总分、即刻记忆因子分及延时记忆因子分均显著低于非MS组(P＜0.05);两组在注意、视觉广度及言语功能因子分上无显著性差异(P均＞0.05).结论 代谢综合征会加重慢性精神分裂症患者的认知功能缺损,在即刻记忆和延时记忆方面损害更明显.     

住院精神分裂症患者并发非酒精性脂肪肝的相关因素分析

目的 了解住院精神分裂症患者非酒精性脂肪肝的患病情况及相关因素.方法 对266例住院精神分裂症患者进行肝胆B超检查,心电图检查,并检测其空腹血糖、血脂、ALT、AST、GGT、AKP、LDH、UA等生化指标.结果 住院精神分裂症患者伴发非酒精性脂肪肝的比例为28.2％,远高于普通人群的患病率.BMI和TG值较大、EKG异常、患糖尿病、胆囊结石、是否服奥氨平与脂肪肝的患病与否等方面存在统计学意义.结论 住院精神分裂症患者伴发非酒精性脂肪肝的比例高,肥胖、高甘油三酯血症、EKG异常、糖尿病、胆囊结石、抗精神病药物是风险因素,值得临床关注.     

精神药物的不良反应（三） 长期住院精神分裂症患者伴发代谢综合征情况

目的：了解长期住院精神分裂症患者伴发代谢综合征（MS）的情况。方法：抽样调查住院至少2年以上的长期住院精神分裂症患者,测定患者身高、腰围、体质量及代谢指标,依据世界糖尿病联盟（IDF）规定的诊断标准甄别出MS患者;同时调查与之相关的抗精神病药使用情况。结果：MS发生率为43.4%,女性52.0%高于男性34.9%（χ2=7.420,P〈0.01）;Logistic回归分析发现MS与性别、体质量指数有关;抗精神病药种类与MS发生无显著相关。结论：长期住院接受抗精神病药治疗的精神分裂症患者伴发MS较高。     

长期住院精神分裂症患者糖代谢异常分析

目的：调查住院慢性精神分裂症患者合并糖代谢异常情况。方法：自制一般情况调查表，回顾糖尿病病史，检测空腹血糖、餐后2h血糖、血脂，计算体重指数(BMI)。结果：305例住院男性慢性精神分裂症患者中，糖尿病25例(8．2％)，糖代谢异常者111例(36．4％)；高年龄、长病程、肥胖者，糖代谢异常发生率高；糖代谢异常组三酰甘油(TG)、BMI较高；病程、TG、肥胖是糖代谢异常发生的危险因素。结论：慢性精神分裂症患者糖代谢异常发生率高于普通人群，临床上应予以关注。     

Analogical reasoning in schizophrenic delusions.

PURPOSE: Reasoning ability has often been argued to be impaired in people with schizophrenic delusions, although evidence for this is far from convincing. This experiment examined the analogical reasoning abilities of several groups of patients, including non-deluded and deluded schizophrenics, to test the hypothesis that performance by the deluded schizophrenic group would be impaired. SUBJECTS/MATERIALS: Eleven deluded schizophrenics, 10 depressed subjects, seven non-deluded schizophrenics and 16 matched non-psychiatric controls, who were matched on a number of key variables, were asked to solve an analogical reasoning task. RESULTS: Performance by the deluded schizophrenic group was certainly impaired when compared with the depressed and non-psychiatric control groups though less convincingly so when compared with the non-deluded schizophrenic group. The impairment shown by the deluded schizophrenic group seemed to occur at the initial stage of the reasoning task. DISCUSSION: The particular type of impairment shown by the deluded subjects was assessed in relation to other cognitive problems already researched and the implications of these problems on reasoning tasks and theories of delusions was discussed.     

Prevalence of Metabolic Syndrome in Hispanic and Non-Hispanic Patients With Schizophrenia

BACKGROUND: Metabolic syndrome, a constellation of truncal obesity, dyslipidemia, disturbed insulin and glucose metabolism, and hypertension, is associated with the development of diabetes mellitus and coronary heart disease. However, the prevalence of metabolic syndrome in Hispanic patients with schizophrenia and whether they differ from comparable non-Hispanic patients is uncertain. METHOD: This cross-sectional study, conducted from January 2002 to May 2002, included 48 patients with schizophrenia who were recruited from an outpatient psychiatric clinic. Metabolic syndrome was defined using the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. RESULTS: The prevalence of metabolic syndrome was 63% in all patients with schizophrenia. The metabolic syndrome was present in 41% of non-Hispanic patients and in 74% of Hispanic patients with schizophrenia. Metabolic syndrome was present in 70% of Cuban Americans and 88% of other Hispanic subgroups with schizophrenia. Metabolic syndrome was associated with waist circumference (p <.05) and high-density lipoprotein cholesterol (p <.05) in logistic regression analysis. CONCLUSIONS: These data suggest that schizophrenic patients have a 3-fold greater risk to develop metabolic syndrome than the general population. Hispanic schizophrenic patients have a significantly greater prevalence of metabolic syndrome than non-Hispanic schizophrenic patients (p <.05). An increased waist circumference is the strongest clinical correlate with metabolic syndrome in schizophrenic patients.     

Clinical evaluation of language and thought disorders in patients with schizophrenic and affective psychoses

56 patients with RDC diagnoses of schizophrenia (n = 40) and mania (n = 16) were interviewed with a structured interviewing procedure. The evaluation was performed by 2 raters who were blind for diagnosis. Two instruments were used for evaluation concerning thought and language disorders: the 'Scale for Assessment of Thought, Language and Communication' developed by Andreasen and the 'Endogenomorphic Schizophrenic Axial Syndrome' by Berner with its emphasis on thought disorders. The interrater reliability for both instruments was found to be good to acceptable for the essential items. A comparison of the frequency of thought disorders according to the two different instruments showed an occurrence of derailment and incoherence of the Andreasen scale in both diagnostic groups, while thought disorders of the schizophrenic axial syndrome were represented only in the group of schizophrenics. This is because in contrast to the Andreasen scale, the presence of pressure of speech is considered as an exclusion criterion for the schizophrenic axial syndrome. Thus, thought disorders according to the schizophrenic axial syndrome are seen to possess diagnostic significance.     

认知行为干预对社区慢性精神分裂症患者康复疗效评估

目的探讨认知行为干预对社区慢性精神分裂症患者的康复疗效。方法将103例日间康复照料机构的慢性精神分裂症患者分成两组,治疗组予以个体或团体认知行为干预,对照组仅予一般的社区随访和疾病指导。采用阳性与阴性症状综合征量表（PANSS）、自知力与治疗态度问卷（ITAQ）、Morningside康复状态量表（MRSS）、社会功能缺陷筛选量表（SDSS）分别于治疗前,治疗1年、2年末进行评定。结果采用认知行为干预的患者阴性量表分降低（t=2．47,P=0．04）;MRSS症状行为表现因子分明显下降（t=3．35,P=0．01）,依赖性因子分低于对照组（t=3．12,P=0．01）,患者的康复状态有进步;研究组的SDSS分值明显低于对照组（t=4．52,P〈0．叭）,而ITAQ分值明显高于对照组（t=2．00,P=0．05）,社会功能缺陷程度明显减轻。结论认知行为干预对社区慢性精神分裂症患者的康复有促进作用。     

精神分裂症免疫功能与血清5-羟色胺的研究

目的:研究阴性型和阳性型精神分裂症患者免疫功能和神经生化物质改变情况及其变化规律.方法:选择阴性型和阳性型精神分裂症患者各20例以及20名正常对照者,抽取静脉血检测T细胞亚群,主要免疫球蛋白和补体C3、C4水平,和血清5-羟色胺(5-HT)水平.结果:阴性型精神分裂症患者CD 3下降,阳性型CD 3、CD 4则升高;IgG、IgA水平2种类型精神分裂症患者均显著降低;5-HT水平阳性型精神分裂症患者显著升高,阴性型精神分裂症患者显著降低.结论:精神分裂症患者伴随有免疫功能的改变,不同类型的精神分裂症其免疫应答参与机制也有不同.     

Altered relationships between metabolic rates of glucose in brain regions of schizophrenic patients

Regional brain glucose metabolism was studied with positron emission tomography (PET) in healthy volunteers (n = 9) and schizophrenic patients (n = 15). The patients were in an acute phase of the disease and drug free. Cerebral metabolic rate with 11C-glucose as the tracer (CMRgl) was determined in both cortical and subcortical structures. In the healthy volunteers significant correlations were found between metabolic rates of some regions, but no relationships were found between CMRgl of limbic cortical areas and that of neocortical or subcortical structures. In the patients, high and significant positive correlations were found between metabolic rates in the neocortical areas, the limbic cortical areas and the subcortical areas. The results indicate differences in the neuronal interplay between regions of healthy and schizophrenic subjects. It is proposed that neuronal systems guiding the specificity and diversity in neuronal functions between different brain regions, are abnormal in schizophrenic patients. Such a disturbance may be the basis for the diversity of psychiatric symptoms in schizophrenics.     

23例精神分裂症患者的多导睡眠图比较研究

目的:探讨以阳性症状为主和以阴性症状为主的精神分裂症的多导睡眠图(PSG)模式,并观察利培酮对精神分裂症PSG的影响.方法:对15例以阳性症状为主和8例以阴性症状为主的精神分裂症患者进行2次的PSG检查,给其中10例服用利培酮治疗6周,观察用药后PSG的变化,结果:精神分裂症患者存在睡眠进程紊乱以及睡眠阶段3,4比例下降,以阳性症状为主的精神分裂症患者和以阴性闰状为主的精神分裂症患者相比,前者有更低的睡眠阶段2比例,用利培酮治疗后,睡眠进程指标改善,睡眠阶段2的时间和比例增加,REM睡眠潜伏期增加,REM强度减少.结论:以阳性症状为主的精神分裂症患者有更低的睡眠阶段2比例可能与该组患者的高警觉性有关.睡眠阶段3,4缺陷可能是一个素质标记,而部分患者REM睡眠指标异常可能是一个状态标记.